HomeMy Public PortalAbout9542 BISBY ST_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type only)
BUILDINGCOUNTY OF LOS ANGELES
ADDRESS 9542 Bisb Street DEPARTMENT OF COUNTY ENGINEER
CITY Tem le Cit ZIP BUILDING AND SAFETY DIVISION
NO.OF BLDGS. BUILDING (—
SIZE OF LOT NOW ON LOT ADDRESS
TRACT BLOCK LOT NO LOCALITY
TEL NEAREST
OWNER Allen NO. CROSS ST.
ASSESSOR
ADDRESS 9542 Bisby Street MAP BOOK PAGE PARCEL
DISTRICT GROUP ITYPE FIRE C SED BY
CITY Temple City ZIP CONST. ZONE
ARCHITECT OR TEL.
y
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO.,:191LDWELL,UNITS BK PG
CONTRACTOR Rigid Mfg. CO. NOL 263-5181 USE ZONE NOP U
LIC. ) SPECIAL
LIC
ADDRESS 337 S / CONDITIONS
CITY Los Angeles Llc.
CLASS C-39 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRONT PROP.LI NE OF (STREET(
O
ADDRESS CITY
HIGH AY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING V
SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE C:)
+ W
DESCRIPTION OF WORK NEW ® CL.
❑ BLDG.S ACK FROMRe-roof with rampnc;it-inxx__ Z
ADD SIDE PROP. (STREET)
ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYP EXISTING
❑
REPAIR
SIDE PROP. LINE HIGHWAY (DTH
USE OF t =
EXISTING BLDG. Residence DEMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATURE)
IN COASTAL ZONE YES ❑ NO ❑
VALUATION•Y v,�J��J� V `' CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION ENVIRONMENTAL
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIAlf IN RELATING TO
WORKMEN'S COMPENSAkftfb f,.. CtJi"1 AN i
SIGNATURE OF (j '
PERMITTEE •
16
ADDRESS
FINAL I BY / y �
TEL.
CITY Los Angeles U NO. DATE
10: F E $ F 15.00
HARVEY T. BRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK M O. CASH PERMIT VALIDATION CK. mo CASH
1 0 '1 5.0 1J
O 9 6�OGi _
76A638A CE-803 12/72